Reversible left anterior descending artery spasm, prolonged cardiac arrestand left main thrombosis during a PTCA attempt of the circumflex artery

The authors report a case of percutaneous transluminal coronary angioplasty of the circumflex artery complicated by occlusion of the non-diseased left anterior descending artery by spasm. During advanced cardiac life support, required for the subsequent cardiac arrest, intra-coronary nitrates and ca lcium antagonists were administered. After 45 minutes, the spasm resolved, but - probably as a result of prolonged blood stasis - a thrombus appeared in the left main artery. While attempting to stent the left main, the throm bus was mechanically dislodged, leaving the epicardial coronary tree free, with a good flow.